Douglas Richard, Wormald Peter-John
Department of Surgery, University of Auckland, Auckland, New Zealand.
Curr Opin Otolaryngol Head Neck Surg. 2007 Jun;15(3):180-3. doi: 10.1097/MOO.0b013e32814b06ed.
The treatment of epistaxis has undergone significant changes in recent years. Gone are the days when patients had an uncomfortable posterior nasal pack inserted then spent several days on the ward only to bleed again on its removal. New packing devices, ingenious haemostatic agents and endoscopic surgical approaches have been developed to provide a variety of effective and well-tolerated treatment options. This paper will discuss the evolution and utility of these devices and techniques for managing difficult epistaxis patients.
Modern packing devices are much easier to insert than traditional gauze packs and are no less effective. A major advance in the management of posterior epistaxis has been the development of the technique of endoscopic ligation.
Anterior epistaxis is generally easy to control with local cautery. The optimal management of posterior epistaxis is to insert a pack to control the bleeding before taking the patient to the operating theatre to ligate the sphenopalatine artery endoscopically.
近年来鼻出血的治疗发生了显著变化。过去那种给患者插入不舒服的后鼻孔填塞物，然后让患者在病房里住上几天，结果取出填塞物时又再次出血的日子已经一去不复返了。新型填塞装置、巧妙的止血剂以及内镜手术方法已经被开发出来，以提供各种有效且耐受性良好的治疗选择。本文将讨论这些用于处理难治性鼻出血患者的装置和技术的演变及效用。
现代填塞装置比传统纱布填塞物更容易插入，且效果不逊色。内镜结扎技术的发展是后鼻孔鼻出血管理方面的一项重大进展。
前鼻孔鼻出血一般通过局部烧灼很容易控制。后鼻孔鼻出血的最佳处理方法是在将患者送往手术室进行内镜下蝶腭动脉结扎之前插入填塞物以控制出血。
